~ 1 ~ * Corresponding author: Govind shukla

E-mail address: govindbbd@gmail.com

IJAMSCR |Volume 1 | Issue 1 | Oct - 2013

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Research article

Prenatal Nutrition:Nutrient recommendations Before, During & After

Pregnancy *,1

Govind shukla, 2Shivani prashar,

3M.sarika,

4Dr.Sunil Yadav,

5Dr.V.Chandramouli,

6C.J. Sampath kumar

1 Research Scholar, Lactonova Research Foundation, Hyderabad,

2Sr. Product Executive,Shrey Nutraceuticals Pvt. Ltd. NewDelhi

3Product Analyst,Lactonova India Hyderabad

4Medical officer-in–charge ,BPHC Bamore JHANSI U.P.

5Consultant Physician & Nutritionist, PrajaVaidyasala,P&T Colony Hyderabad

6Managing Director, Lactonova India Hyderabad

ABSTRACT Nutrition before and during pregnancy has a profound effect on the development of infants. This is a rather critical time

for healthy fetal development as infants rely heavily on maternal stores and nutrient for optimal growth and health

outcome later in life. Prenatal nutrition addresses nutrient recommendations before and during pregnancy. Birth weight

of the newborn at delivery reflects the sufficiency and the quality of maternal nutrient for the fetus during pregnancy.

Prenatal nutrition has a strong influence on birth weight and further development of the infant. The present paper

reviews the role of prenatal nutrition in pregnancy.

KEYWORDS: Prenatal nutrion, Pregnancy, Foetal development during pregnancy.

INTRODUCTION

In a precursory study into the link between

nutrition and pregnancy in 1950 women who

consumed minimal amounts over the eight week

period had a higher mortality or disorder rate

concerning their offspring than women who ate

regularly, attributed to the fact that the children

born to well-fed mothers had less restriction within

the womb.[1]

Not only have physical disorders been linked with

poor nutrition before and during pregnancy, but

neurological disorders and handicaps are a risk that

is run by mothers who are malnourished, a

condition which can also lead to the child

becoming more susceptible to later degenerative

disease(s).[2]

23.8% of babies are estimated to be

born with lower than optimal weights at birth due

to lack of proper nutrition.[3]

It is very important that expecting mothers should

change their personal habits like smoking, alcohol,

caffeine, using certain medications and street drugs

as soon as they know they are pregnant or even

when they are planning to conceive. All these can

affect the development of the organs like brain,

which happen in early stages of pregnancy. They

can cause irreparable damage to the growing

foetus.[4]

The expecting mothers should be very calm and

peaceful, also focussed on what they should do for

a healthy pregnancy.

NUTRITION REQUIREMENT BEFORE

PREGNANCY

International Journal of Allied Medical Sciences

and Clinical Research (IJAMSCR)

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Pre-natal nutrition

As with most diets, there are chances of over-

supplementing, however, as general advice, both

state and medical recommendations are that

mothers follow instructions listed on particular

vitamin packaging as to the correct or

recommended daily allowance (RDA).

Fig: 1 Building blocks for a Healthy Baby

Protein is needed for the buildup of muscles,

uterus, breasts, blood supply, and baby’s

tissues. Low protein intake is related to

smaller-than-average weight babies who may

have health problems. Pregnant and

breastfeeding women need around 71 grams of

protein per day.

Folate is a vitamin that is required to build

protein tissues. Low folate levels are linked to

birth defects, such as spina bifida. These

defects form early in pregnancy, often before

women know they are pregnant. The dietary

reference intake for folate is 400 micrograms

per day before pregnancy, 600 micrograms per

day during pregnancy, and 500 micrograms per

day while breastfeeding.

Calcium is needed for strong bones. Pregnant

and breastfeeding women 19 and older need

around 1,000 milligrams per day or 1,300

milligrams per day for women under 19 years

of age. Low zinc levels during pregnancy can

cause long labor and small babies who may

have health problems. The dietary reference

intake for zinc is 11 milligrams per day or 12

milligrams per day for women under 19 years

of age. Women who are breastfeeding need

about the same amount (12 milligrams per day

or 13 milligrams per day for women under 19).

Iron deficiency is common in pregnant women.

Both mother and baby need iron for their

developing blood supplies. A developing baby

also stores iron for use after birth. This

increases the mother’s iron needs. It is

practically impossible to get enough iron from

food. All pregnant women need around 27

milligrams per day. The need for iron declines

after birth but women who are breastfeeding

still require about 10 milligrams a day.

Magnesium and zinc supplementation for the

binding of hormones at their receptor sites.

Regular vitamin D supplementation

decreases the chances of deficiencies in

adolescence. More importantly, it is known to

reduce the likelihood of rickets with pelvic

malformations which make normal delivery

impossible.

Regular vitamin B12 supplementation,

again is known to reduce the chances of

infertility and ill health.

Omega-3 fatty acids increase blood flow

to reproductive organs and may help regulate

reproductive hormones.[5]

Consumption is also

known to help prevent premature delivery and

low birth weight.[6]

The best dietary source of

omega-3 fatty acids is oily fish. Some other

omega-3 fatty acids not found in fish can be

found in foods such as flaxseeds, walnuts,

pumpkin seeds, and enriched eggs.[5]

The DHA intake from an average diet

during pregnancy is only 80 mg DHA per day,

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based on a paper in the Journal of Nutrition,

2005 (Denomme et al. 135: 206-211).

A minimum 300 mg DHA daily is

suggested based on a 1999 NIH body of

experts recommending needed levels to

support fetal brain development and visual

acuity benefits. Most notably, the last trimester

is the most critical period for DHA during

pregnancy for the baby's brain growth in the

womb.

DHA (Docosahexaenoic acid, an omega-3

long chain polyunsaturated fatty acid) is found

in every cell in our bodies. It is critical for

brain, eye and central nervous system

development and functioning. During

pregnancy, developing babies rely on their

mothers to get needed DHA. Since DHA is

derived from the foods we eat, the content of

DHA in a mother's diet determines the amount

of DHA passed on to her developing baby.

Unfortunately, the majority of pregnant

womens fail to get the recommended amount

of DHA in their diets and DHA is not found in

most prenatal vitamins.

A 2003 study published in the journal

Pediatrics showed children whose mothers

took a DHA supplement during pregnancy

scored higher on intelligence tests at four years

of age than children of mothers not taking

DHA supplements.

A 2004 study published in Child Development

found that babies whose mothers had high

blood levels of DHA at delivery had advanced

attention spans into their second year of life.

During the first six months of life these infants

were two months ahead of babies whose

mothers had lower DHA levels.

Other research studies suggest breastfed babies

have IQs of six to 10 points higher than

formula-fed babies. Medical and nutritional

experts attribute this difference to the DHA

infants receive while nursing. (Obstetrics &

Gynecology, 2003).

In a trial of women receiving DHA

supplementation during the third trimester, the

average length of gestation increased six days

(Obstetrics & Gynecology, 2003).

Research has found low levels of DHA in

mother's milk and in the red blood cells of

women with postpartum depression. (Journal

of Affective Disorders, 2002). Some scientists

believe increasing levels of maternal DHA

may reduce the risk of postpartum depression.

Nutrition requirement of mothers during

pregnancy

The conception and the subsequent weeks

afterwards is the time when it is at its most

vulnerable, as it is the time when the organs and

systems develop within. The energy used to create

these systems comes from the energy and nutrients

in themother's circulation, and around the lining of

the womb, such is the reason whycorrect nutrient

intake during pregnancy is so important.

Fig: 2 Weight Vs Gestational age:

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Foetal development during pregnancy

Gestation is the period of embryo development

from conception to birth.Gestation is about 40

weeks in humans and is divided into three

trimesters, each spanning 3 months..Gestational

stages, on the other hand, are based on

physiological fetal development, which include

blastogenesis, embryonic stage and fetal stage.

Blastogenesis is the stage from fertilization to

about 2 weeks. The fertilized egg or the zygote

becomes a blastocyst where the outer layer and the

inner cell mass differentiate to form placenta and

the fetus respectively. Implantation occurs at this

stage where the blastocyst becomes buried in the

endometrium.

Embryonic stage is approximately from 2 weeks

to 8 weeks. It is also in this stage where the

blastocyst develops into an embryo, where all

major features of human are present and

operational by the end of this stage.

Fetal stage is from 9 weeks to term. During this

period of time, the embryo develops rapidly and

becomes a fetus. Pregnancy becomes visible at this

stage.

Fig:3 Foetal development during pregnancy

Embryo at 2 month Fetus at 4 month Fetus at 8 month

During the early stages of pregnancy, since the

placenta is not yet formed, there is no mechanism

to protect the embryo from the deficiencies which

may be inherent in the mother's circulation. Thus, it

is critical that an adequate amount of nutrients and

energy is consumed. Additionally, the frequent

consumption of nutritious foods helps to prevent

nausea, vomiting, and cramps.[7]

Supplementing

one's diet with foods rich in folic acid, such as

oranges and dark green leafy vegetables, helps to

prevent neural tube birth defects in the baby.

Consuming foods rich in iron, such as lean red

meat and beans help to prevent anemia and ensure

adequate oxygen for the baby.[8]

A necessary step

for proper diet is to take a daily prenatal vitamins,

that ensure their body gets the vitamins and

minerals it needs to create a healthy baby. These

vitamins contain folic acid, iodine, iron, vitamin A,

vitamin D, zinc and calcium.[9]

Recommended Food hygiene during

pregnancy

It is advised for pregnant women to pay special

attention to food hygiene during pregnancy in

addition to avoiding certain foods in order to

reduce the risk of exposure to substances that may

be harmful to the developing fetus. This can

include food pathogens and toxic food components,

alcohol, and dietary supplements such as vitamin

A.[6]

Dietary vitamin A is obtained in two forms which

contain the preformed vitamin (retinol), that can be

found in some animal products such as liver and

fish liver oils, and as a vitamin A precursor in the

form of carotenes, which can be found in many

fruits and vegetables.[6]

Intake of retinol, in extreme

cases, has been linked to birth defects and

abnormalities. However, regular intake of retinol is

not seen as dangerous. It is noted that a 100 g

serving of liver may contain a large amount of

retinol, so it is best that it is not eaten daily during

pregnancy, something which is also the same with

alcohol intake in binge drinking.

Excessive amounts of alcohol have been proven to

cause fetal alcohol syndrome. The World Health

Organization recommends that alcohol should be

avoided entirely during pregnancy, given the

relatively unknown effects of even small amounts

of alcohol during pregnancy.[10]

Pregnant women are advised to pay particular

attention to food hygiene and to avoid certain foods

during pregnancy in order to minimize the risk of

food poisoning from potentially harmful pathogens

such as listeria, toxoplasmosis, and salmonella.

Pregnant women are therefore advised to avoid

foods in which high levels of the bacteria have

been found, such as in soft cheeses. Listeria are

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destroyed by heat and therefore pregnant women

are advised to reheat ready-prepared meals

thoroughly. Pregnant women should also wash

their fruit and vegetables very thoroughly in order

to minimize risk. Salmonella poisoning is most

likely to come from raw eggs or undercooked

poultry.[6]

Maternal obesity has a significant impact

on maternal metabolism and offspring

development.[11]

Insulin resistance, glucose

homeostasis, fat oxidation and amino acid synthesis

are all disrupted by maternal obesity and contribute

to adverse outcomes.[11]

Modification of lifestyle is

an effective intervention strategy for improvement

of maternal metabolism and the prevention of

adverse outcomes.[11]

Table:1 Recommended prenatal nutrients during pregnancy

Nutrient Recommendation (Extra = Above RDA) Maximum/Total

amount

Energy

Increase by 200 kcal (840 kJ) per day in last trimester

only. RDA

Proteins Extra 6 g per day 51 g per day

Thiamin Increase in line with energy; increase by 0.1 mg per day 0.9 mg per day

Riboflavin Needed for tissue growth; extra 0.3 mg per day 1.4 mg per day

Niacin

Regular supplementation/diet of substance. No increase

required. RDA

Folate Maintain plasma levels; extra 100 µg per day 300 µg per day

Vitamin C Replenish drained maternal stores; extra 120 mg per day 50 mg per day

Vitamin D Replenish plasma levels of vitamin 10 µg per day. RDA

Calcium Needs no increase RDA

Iron Extra 3 mg per day needed RDA

Magnesium, zinc, and

copper Normal supplementation or consumption. RDA

Iodine Extra 100 µg per day. 250 µg per

day[12][13][14][15]

Folate requirement in in pre-and peri-

conception.

Folic acid, which is the synthetic form of the

vitamin folate, is extremely critical both in pre-and

peri-conception.[6]

Deficiencies in folic acid may

cause neural tube defects; women who had 4 mg of

folic acid in their systems due to supplementing 3

months before childbirth significantly reduced the

risk of NTD within the fetus. This is now

advocated by the UK department of health,

recommending 400 µg per day of folic acid.

The development of every human cell is dependent

on an adequate supply of folic acid. Folic acid

governs the synthesis of the precursors of DNA,

which is the nucleic acid that gives each cell life

and character. Folic acid deficiency results in

defective cellular growth and the effects are most

obvious on those tissues which grow most

rapidly.[16]

Leafy green vegetables, such as cabbage, broccoli

and greens are all good sources of naturally

occurring form of folic acid, folate.

Along with neural tube development, folate affects

DNA synthesis in multiple ways. Folate is involved

in the construction of purines and pyrimidines, the

building blocks of nucleic acids.[17]

Folate is also

necessary to make s-adenosylmethionine (SAM),

which acts as a methyl donor in the synthesis of

DNA.[17]

Because of its role in these important

mechanisms, fetal DNA would be significantly

altered if a maternal folate deficiency is present.

One possible outcome is DNA mutation, which

could prevent normal gene expression. For

example, a tumor-suppressing gene might be turned

off, altering normal immune function in preventing

cancer growth.[17]

Thompson et al.[18]

examined the

relationship between maternal supplementation of

folate and iron during pregnancy and incidences of

acute lymphoblastic leukemia (ALL) in their

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children. Increased rates of ALL were found in

children whose mothers did not take iron and folate

supplements. Iron alone did not seem to reduce the

risk of developing ALL, however iron in

combination with folate was shown to have a

protective effect in decreasing the risk for ALL.

Thompson and his associates (2001), concluded

that maternal folate supplementation throughout

pregnancy plays an important role in reducing the

risk for childhood ALL.[18]

Water, an important aspect of nutrition

throughout pregnancy.

During pregnancy, one's mass increases by about

12 kg.[19]

Most of this added weight (6 to 9 L) is

water[19]

because the plasma volume increases, 85%

of the placenta is water[20]

and the fetus itself is 70-

90% water. This means that hydration should also

be considered an important aspect of nutrition

throughout pregnancy. To ensure healthy hydration

during pregnancy, the European Food Safety

Authority recommends an increase of 300 mL per

day compared to the normal intake for non-

pregnant women, taking the total adequate water

intake (from food and fluids) to 2,300 mL, or

approximately 1,850 mL/ day from fluids alone.[21]

Proper nutrition is important after delivery to help

the mother recover, and to provide enough food

energy and nutrients for a woman to breastfeed her

child. Women having serum ferritin <= 70 µg/L

may need iron supplements to prevent iron

deficiency anaemia during pregnancy and

postpartum.[22][23]

During lactation, water intake needs increase to

compensate for the loss of water through milk

production. Milk is made of 88% water, and the

European Food Safety Authority therefore

recommends that breastfeeding women increase

their water intake by about 700 mL/day, giving an

adequate volume of 2,700 mL/day (from food and

drink), or approximately 2,200 mL/day from

fluids.[21]

Practical Recommendations for Pregnant

Mothers

The following general tips can be helpful to

pregnant women. It would be beneficial to maintain

adequate physical activity to meet energy needs

from the food consumed. Eating a balanced diet

would be optimal for healthy pregnancy results. To

prevent problems like dehydration and

constipation, it is important to drink enough fluids,

especially water, to support blood volume increases

during pregnancy. It is recommended to

accompany regular meals with a daily prenatal

vitamin supplement that has sufficient folic acid

and iron content.

If the fetus is predicted to have low birth weight, it

would be ideal to increase caloric intake, which can

be done by having extra Food Guide Servings

daily. If the fetus is predicted to have high birth

weight, smaller and more frequent meals should be

consumed to allow better weight management.

Moderate sugar intake, such as fruit juices, is also

suggested. It is essential to limit food and

beverages with high calories and salt content.

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